Mad in America: Rethinking Mental Health

This week on MIA Radio, we present a special episode of the MIA podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2019. 2019 represents the fourth annual awareness day and each year it’s held on July 11 which is a significant date because it is the birthday of Professor Heather Ashton. Dr. Ashton is a world-leading expert in benzodiazepines and wrote the highly regarded Ashton Manual which aims to aid clinicians and patients in coming off benzodazepine drugs safely. She also spent many years personally assisting and supporting those who had experienced protracted benzodiazepine withdrawal. Around the world there are many activities and events taking place as part of W-BAD, so to follow along with events and to get involved yourself, head over to World Benzodiazepine Awareness Day’s Facebook page and look out for the hashtag #WorldBenzoDay on social media. In our two-part podcast, we hear from W-BAD volunteer and Project Manager for W-BAD Rocks of Kindness, Janelle. We also chat with physician and Director of the Benzodiazepine Information Coalition Christy Huff MD. Finally, in part two, we hear from Stephen Wright MD, addiction specialist and medical consultant to the Alliance for Benzodiazepine Best Practices. W-BAD Rocks on Facebook Rockin’ Against Benzos (closed Facebook group) A Rockin’ Creative Outlet That’s Raising Benzodiazepine Awareness #WBADROCKS – 1 Month, 5 Things We’ve Learned W-BAD Rocks on Twitter and Instagram: @wbadrocks On social media, look for the hashtag #WBADROCKS A Xanax Prescription That Should Have Been Rejected 10 Tips To Help Patients Through Benzodiazepine Withdrawal Follow Dr. Huff on Twitter Dr. Huff’s Blogs and Media Appearances (Scroll down below her bio and click on logos) BIC on Facebook @bzinfocoalition BIC on Twitter @BZInfoCoalition The Alliance for Benzodiazepine Best Practices Benzodiazepine Related Problems: It’s Almost Never Addiction Benzodiazepines and Z Drugs for Pain Patients: The Problem of Protracted Withdrawal Symptoms (PWS) How Chronic Administration of Benzodiazepines Leads to Unexplained Chronic Illnesses: A Hypothesis

This week on MIA Radio, we present a special episode of the MIA podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2019. 2019 represents the fourth annual awareness day and each year it’s held on July 11 which is a significant date because it is the birthday of Professor Heather Ashton. Dr. Ashton is a world-leading expert in benzodiazepines and wrote the highly regarded Ashton Manual which aims to aid clinicians and patients in coming off benzodazepine drugs safely. She also spent many years personally assisting and supporting those who had experienced protracted benzodiazepine withdrawal. Around the world there are many activities and events taking place as part of W-BAD, so to follow along with events and to get involved yourself, head over to World Benzodiazepine Awareness Day’s Facebook page and look out for the hashtag #WorldBenzoDay on social media. In our two-part podcast, we hear from W-BAD volunteer and Project Manager for W-BAD Rocks of Kindness, Janelle. We also chat with physician and Director of the Benzodiazepine Information Coalition Christy Huff MD. Finally, in part two, we hear from Stephen Wright MD, addiction specialist and medical consultant to the Alliance for Benzodiazepine Best Practices. W-BAD Rocks on Facebook Rockin’ Against Benzos (closed Facebook group) A Rockin’ Creative Outlet That’s Raising Benzodiazepine Awareness #WBADROCKS – 1 Month, 5 Things We’ve Learned W-BAD Rocks on Twitter and Instagram: @wbadrocks On social media, look for the hashtag #WBADROCKS A Xanax Prescription That Should Have Been Rejected 10 Tips To Help Patients Through Benzodiazepine Withdrawal Follow Dr. Huff on Twitter Dr. Huff’s Blogs and Media Appearances (Scroll down below her bio and click on logos) BIC on Facebook @bzinfocoalition BIC on Twitter @BZInfoCoalition The Alliance for Benzodiazepine Best Practices Benzodiazepine Related Problems: It’s Almost Never Addiction Benzodiazepines and Z Drugs for Pain Patients: The Problem of Protracted Withdrawal Symptoms (PWS) How Chronic Administration of Benzodiazepines Leads to Unexplained Chronic Illnesses: A Hypothesis

Last year, Lucy Johnstone and her colleagues in the UK launched the Power Threat Meaning Framework (PTMF), a set of ideas that represented a sharp departure from the biomedical conceptions that animate the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). This framework shifts the notion of “what is wrong with you” in the DSM to “what has happened to you,” and by doing so turns away from a medical process bent on diagnosing broken brains and toward a narrative response that tells of contexts, power dynamics, and systems. At a time when the Movement for Global Mental Health is intent on exporting the Western biomedical approaches around the world, Johnstone and her PTMF team, which has included numerous individuals who identify as service users/survivors, are seeking to promote a radically different way of understanding distress. Responses to the PTMF have ranged the gamut from criticism to gratitude. Johnstone, a consulting clinical psychologist who has experience working in adult mental health settings for many years, believes that the current mental health system has failed, and we are now in the process of witnessing its inevitable downfall. She questions whether a mental health system is needed at all. However, as Thomas Kuhn wrote in his work on scientific revolutions, a system cannot be fully abandoned until there exists a conceptual alternative for the system to move towards. The PTMF, Johnstone believes, offers that conceptual alternative that is necessary for a revolution. In this interview, she reflects on the reaction to the PTMF, and the possibility that it will help stir up a revolution in the field. How is the framework to be used? Does it stand a chance of becoming adopted? She also tells of how her own life experiences and the influences on her work. Relevant Links Dr. Johnstone took part in an earlier interview after the PTMF was launched. You may view this interview here: https://www.madinamerica.com/2018/03/dr-lucy-johnstone-power-threat-meaning-framework/ More about the PTMF: Lucy Johnstone discussing the primary features of PTMF: https://www.youtube.com/watch?v=tkNWQdVB4F0 A British Psychological Society report (with full document link to the framework included): https://www.bps.org.uk/news-and-policy/introducing-power-threat-meaning-framework © Mad in America 2019

This week on MIA Radio, we continue our series of discussions with Doctor Lee Coleman. In previous podcasts, we have discussed Lee’s views as a critical psychiatrist and the role of psychiatry in the courtroom. This time, we turn our attention to the need for action to address the inherent power held by psychiatry and how society might respond. In this episode we discuss: How language has the power to trigger associations and can lead us to not question theories that are presented to us as facts. How we have come to equate psychiatric ‘treatment’ with interventions in other areas of medicine. The deception behind the names of the drugs used in psychiatry such as ‘antidepressants’ or ‘antipsychotics’. That society may well be blinded by language to the critical issues of the use of force and the relationship between the law and psychiatry. That, ultimately, society demands that psychiatry play the role that it does and therefore we need a societal and political response. That any movement to address the dominance of the medical model needs to educate the public at large and so needs resources to be able to provide that challenge. How the media often provides an amplified voice for mainstream messages leading to normalisation and lack of critical questioning of such messages. That we can and should partner with sympathetic media channels who are open to challenging mainstream messaging. That Lee will hopefully be leading a workshop at the 2019 NARPA (National Association for Rights Protection and Advocacy) Conference in Connecticut, USA. Relevant Links Article - Technology and Psychiatry NARPA 2019 Conference YouTube - Psychiatry's "War of the Words" YouTube - Dealing With Powerful Opponents: Psychiatry, Government and Pharma To get in touch, email us at podcasts@madinamerica.com © Mad in America 2019

On MIA Radio this week, MIA’s Tim Beck interviewed Dr. Felicity Thomas and Dr. Richard Byng. Dr. Thomas is a Senior Research Fellow in the Medical School and a Senior Research Fellow on the Cultural Contexts of Health in the College of Humanities at the University of Exeter. She is also a co-director (with Professor Mark Jackson) of the WHO Collaborating Centre on Culture and Health and works closely with the WHO Regional Office for Europe project on the Cultural Contexts of Health. Dr. Byng is a professor in primary care research at the University of Plymouth. Dr. Byng is also trained as a general practitioner with a particular interest in mental health care. Over the last 20 years, he has worked on various large-scale research projects related to access, commissioning, inter-professional working and implementation of evidence-based practice, while publishing extensively on topics related to the social contexts of health and professional care. Together, Dr. Thomas and Dr. Byng have contributed to the DeSTRESS project, which consists of a team of researchers in the United Kingdom who seek to learn about why and how poverty-related issues have become increasingly pathologized. This includes exploring how high levels of antidepressant prescription and use are impacting people’s health and wellbeing in low-income communities in southwest England. Their final report published in April 2019, entitled Poverty, Pathology, and Pills, situates increasing rates of mental health diagnosis and psychiatric prescriptions within socioeconomic and policy trends across the UK. An overarching conclusion of this research was that there is a need to reconceptualize the way that health professionals respond to poverty-related distress. This requires a response that recognizes the bio-psycho-social and reduces pressures on general practitioners (GPs) to make rapid decisions around diagnosing and prescribing.

On MIA Radio this week, MIA’s Gavin Crowell-Williamson interviewed Adriane Fugh-Berman, MD, a professor in the Department of Pharmacology and Physiology and in the Department of Family Medicine at Georgetown University Medical Center (GUMC). She is the director of PharmedOut, a GUMC research and education project promoting rational prescribing and exposing the effects of pharmaceutical marketing on prescribing practices. Dr. Fugh-Berman leads a team of volunteer professionals that has deeply impacted prescribers’ perceptions of the adverse consequences of industry marketing. She is interested in physician-industry relationships and is an expert witness in litigation regarding pharmaceutical marketing processes. She was formerly a medical officer in the Contraception and Reproductive Health Branch of the National Institute for Child Health and Human Development. Dr. Fugh-Berman is the lead author on key articles on physician-industry relationships, including a national survey of industry interactions with family medicine residencies, exposés of how ghostwritten articles in the medical literature are used to sell drugs, an analysis of drug rep tactics, and an explanation of industry publication planning.  She wrote the first chapter on alternative medicine to appear in Harrison’s Principles of Internal Medicine and authored the first clinicians’ reference text on dietary supplements, the 5-Minute Herb and Dietary Supplement Consult, as well as an evidence-based book aimed at consumers, Alternative Medicine: What Works.  In addition to dozens of articles in peer-reviewed literature, Dr. Fugh-Berman coauthored The Truth about Hormone Therapy and co-edited The Teratology Primer. Dr. Fugh-Berman is the former chair of and currently writes a column for the National Women’s Health Network, a consumer advocacy group that takes no money from industry. Dr. Fugh-Berman has appeared on 20/20, the Today Show, and every major news network.

On MIA Radio this week, MIA’s Peter Simons interviewed David Cohen, PhD, a social worker, professor of social welfare, and Associate Dean for Research at the Luskin School of Public Affairs of the University of California, Los Angeles. He discussed his path to becoming a researcher focused on mental health, coercive practices, and discontinuation from psychiatric drugs. He studies the social construction of psychoactive drug effects, the union of law and psychiatry within a criminalization/medicalization system and envisions alternatives to the current mental health industrial complex and the medicalization of everyday life. He has also taught in Canada and France, and for over 20 years held a private practice to help people withdraw from psychiatric drugs. He is the author of over 100 book chapters and articles. His first book, published in 1990, was Challenging the Therapeutic State: Critical Perspectives on Psychiatry and the Mental Health System. His latest book, published in 2013, with colleagues, Stuart Kirk, and Tomi Gomory is Mad Science: Psychiatric Coercion, Diagnosis and Drugs.

On MIA Radio this week, MIA’s Akansha Vaswani interviewed Dr. John Read, a clinical psychologist at the University of East London, about the influences on his work and research on mental health over the years. John worked for nearly 20 years as a Clinical Psychologist and manager of mental health services in the UK and the USA, before joining the University of Auckland, New Zealand, in 1994, where he worked until 2013. He has published over 140 papers in research journals, primarily on the relationship between adverse life events (e.g. child abuse/neglect, poverty, etc.) and psychosis. He also researches the negative effects of biogenetic causal explanations on prejudice, the opinions, and experiences of recipients of antipsychotic and antidepressant medication, and the role of the pharmaceutical industry in mental health research and practice. John is on the Boards of the Hearing Voices Network – England, the International Institute for Psychiatric Drug Withdrawal and the UK branch of the International Society for Psychological and Social Approaches to Psychosis (www.isps.org). He is the Editor of the ISPS scientific journal ‘Psychosis.’  

This week on MIA Radio, we present our second chat with Doctor Lee Coleman. In the first interview in this series, we discussed Lee’s career, his views as a critical psychiatrist and his 1984 book Reign of Error. For this second interview, we focus on psychiatry in the courtroom and why the psychiatric expert witness role may be failing both the individual on trial and society at large. We also focus on Chapter 3 of Reign of Error: The Insanity Defence, Storytelling on the Witness Stand. In this episode we discuss: What led Lee to his involvement in the courtroom as a psychiatrist testifying as to the reliability of psychiatric testimony itself. How both psychiatrists and psychologists have been given a role by society to judge both the current mental state of an individual on trial and also the potential future behaviour of that individual. How important it is to address the three dimensions of past, present and future when looking at psychological testimony. The role of psychiatry in the trial of Patty Hearst, when required to provide evidence that she has been brainwashed and therefore was incompetent to stand trial. How Lee and a colleague, George Alexander, came to arrange a press conference to address the issue of the reliability of psychiatric or psychological testimony. How speaking out in this way ultimately led to many years of opposition not only by psychiatry but also by attorneys on both sides of the debate. The legal definition of the term ‘insanity’ and the context in which it is used. How if someone is found legally insane, the punishment may be far worse and the incarceration far longer than if that person were found guilty. The details surrounding the trial of Dr. Geza De Kaplany, who committed a gruesome murder but came to be represented at trial as having multiple personalities and being mentally disordered. The inconsistency often found in both the defense and prosecution in the courtroom when it comes to subjective assessments of the mental state of an individual. That it is crucial that people band together to share information and to actively demonstrate and have conferences and influence legislators because we can’t rely on media channels and we can’t rely on professional bodies. Relevant Links: Doctor Lee Coleman The Reign of Error YouTube - Competent to Stand Trial?- A Psychiatric Farce YouTube - Society Doesn't Need Protection from the "mentally ill" The Trial of Patty Hearst Geza De Kaplany To get in touch, email us at podcasts@madinamerica.com

On MIA Radio this week, MIA’s Jessica Janze interviewed Dr. Jonathan Raskin, in the Department of Psychology at the State University of New York at New Paltz where he serves as department chair and teaches classes in psychology and counselor education. Dr. Raskin’s research is focused on constructivist meaning-based approaches in psychology and counseling. He recently authored a textbook titled Abnormal Psychology: Contrasting Perspectives. Dr. Raskin describes a recent article he wrote (What Might an Alternative to the DSM Suitable for Psychotherapists Look Like?) that highlights psychotherapists’ dissatisfaction with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and suggests some principles for building alternative models.  What follows is a transcript of the interview, edited for clarity. **************** JJ: Welcome, Jonathan. I'm very excited to have you. Is there anything else you want to add about your background for our readers before we get started? JR: No, not at all. Thank you for inviting me to do this. JJ: Let's get started. What made you interested in working on alternative diagnostic systems for use in psychotherapy? JR: Yeah, that's a good question. I've always been interested in how people make meaning, and diagnostic systems are the way that mental health professionals make meaning of their client's experiences. So to me, all diagnostic systems are meaningful systems for making sense of the problems our clients bring to us. JJ: You take a constructivist approach to thinking about diagnosis. Can you break down what that means for us and how it applies to this issue of diagnosis?  JR: Many theories fall under the banner of constructivism, but broadly speaking, constructivism focuses on how people both individually and in conjunction with one another (and in more social kinds of configurations) construct understandings of themselves and the world. Then they use those constructions to guide their lives. To me, constructivism seems like an excellent theoretical approach to use in understanding diagnosis because each diagnostic approach can be viewed as a constructed meaning system for understanding and conceptualizing client concerns. JJ: Several alternative diagnostic systems have been promoted in recent years, including HiTop, the Power Threat Meaning framework, RDoC, and the PDM. What are your thoughts on these alternatives? JR: I think they're all interesting in their own ways. Let me talk about a few of them. I'll start with HiTop. That's the hierarchical taxonomy of psychopathology. It's a dimensional approach that tries to address the problem of comorbidity that afflicts DSM categories. Comorbidity is a confusing issue for people. When disorders are comorbid, they're diagnosed at the same time. One of the problems is that a lot of the DSM diagnoses are comorbid with one another. If you have too much comorbidity, the question that arises is, are the categories that we've constructed distinct from one another? HiTop thinks that comorbidity should be embraced instead of rejected. They say, “Yes, these DSM categories cluster together, we can group each of them under these broader spectrums.” The HiTop system uses six spectrum dimensions. Ultimately, the people who created HiTop feel that DSM disorders might be discardable, but for the time being, we can keep them. They say that there are really these co-morbid overlapping categories underneath these higher levels, six distinct spectra. HiTop sees this as a simpler approach because you can divide people's problems into how they score along these six different spectrum dimensions. It's still very early going. I think it has a lot in common with the big five personality research. If you like those, you'll like HiTop. If you don't like those, you might not be a fan of HiTop. Let me talk a little bit about RDoC. RDoC is the research domain criteria system. It's a research initiative at the moment. It's not a diagnostic system yet. They're trying to build a diagnostic system from the ground up, and they're doing that by trying to identify the ways that the brain is designed to function. Then, and only then, they will identify ways that it malfunctions. And so the categories that they create will be based on their identifying and diagnosing these specific malfunctions. The people involved in RDoC say, “We're doing this in the right way, whereas the DSM does it backward.” DSM starts with categories and then researchers race around trying to find out what the biological correlates of those categories are. RDoC says, “Let's understand the brain and how it works and then build categories based on observable differences between healthy and unhealthy brains.” It's a very medical model kind of approach. And if you like that, you'll like RDoC. If you don't like the medical model, you won't. What's really fascinating about [RDOC] is the idea that it wants to build the system from the ground up. It is not yet a diagnostic system; it's a research initiative. We don't have the ability to identify any kind of presenting problems based exclusively on these kinds of biological biomarkers just yet. Then there's the Power Threat Meaning framework (PTM), which is going 180 degrees in the other direction. PTM shifts the focus. It moves away from the medical model. It actually doesn't consider itself a diagnostic system. It rejects the idea of medical model diagnostic systems. It says that we need to depathologize people's problems by focusing on what the PTM identifies as the actual causes. It says that economic and social injustices are the root causes of emotional distress. The origins of distress lie outside the person. RDOC looks inside the person, and I think the DSM, in many respects, implies that it's inside the person. PTM emphasizes what has happened to people on a socio-cultural level and then how they've responded to it. It's a totally different approach. It's a non-diagnostic approach. Another approach is the Psychodynamic Diagnostic Manual (PDM). From its name, you can tell it’s an explicitly psychodynamic diagnostic manual that diagnoses problems through the lens of psychodynamic theory. So whereas the DSM has traditionally been atheoretical, in the sense that it's a descriptive, diagnostic manual describing problems, but it doesn't take a stance on what causes them, the PDM roots its approach explicitly in psychodynamic theory. All of these approaches are really interesting in their own way. The question is whether or not they'll catch on. JJ: You don't think that there is one particular diagnostic system that our society should switch to, is that correct? JR: I view diagnostic systems as tools. Like hammers, they're really helpful instruments. However, depending on the task I’m up to, I might be better off with a wrench or a pair of pliers or some other tool instead. So, I find it helpful to use the tools metaphor when considering diagnostic systems. One might find a given diagnostic system useful, or not, depending on the situation. Of course, it's always important to remember that diagnostic systems provide maps that can guide us, but we have to be careful not to mistake the map for the territory. I think the biggest barrier to developing viable alternatives to the DSM and the ICD is that these approaches cross theoretical perspectives by being mainly descriptive. But, when it comes to how a diagnostic system informs treatment, descriptive approaches, in many ways are lacking. That is, they don't take any stance on how to best approach the problems they identify or describe. So, their wanting to script nature makes DSM and ICD easy for everyone to adopt regardless of the theoretical viewpoint. But any theoretically driven system, things like the PDM or the power threat meaning framework or RDoC even, those systems in many ways might struggle to gain mass acceptance because their theoretical commitments will turn people off. Somebody who doesn't like a medical model brain approach won't use RDoC. Somebody who's really opposed to psychodynamic theories, or just not interested in them, won't use PDM. Somebody who doesn't take a social justice orientation to problems might not like PTM. By being theoretically well developed and informative about how to conceptualize and approach client problems, these alternative diagnostic systems ironically make themselves less broadly appealing. That can be a challenge for them. But, if they are tools you don't have to stick with just one, you could jump around from one system to the next depending on what you're up to that day. JJ: What about insurance companies? What do you think an alternative to the DSM system that could be used for insurance purposes would look like? JR: I’m not sure. It’s been suggested by a lot of people that a very practical thing we can do is use the DSM-5 V codes (which list circumstances or experiences, such as "Homelessness," "Poverty," and "High Expressed Emotion Level Within Family") because that might let us identify presenting problems while being less medicalizing and stigmatizing. Practically, those codes already exist, but we would need insurers to cover them for clinicians to begin using them. One of the reasons they don't get used is that insurance companies don't cover the code diagnosis. As I was describing a minute ago, I think theoretically coherent systems might prove to be more helpful to clinicians in a practical, everyday manner but they're less likely to be appreciated and used across clinicians and different theoretical orientations. That's the challenge. Being theoretically consistent and pure and developing something that a smaller group of people might like to use versus having something that would kind of cut across all theoretical orientations. The latter might be more descriptive, but potentially not the most clinically useful, but would help grease the wheels of insurance. JJ: Can you talk more about the importance of including service users and people with lived experiences in the development of any future alternatives? JR: I think it's very important to listen to service users because they're the ones impacted by whatever diagnostic system we develop and use. So we really need their feedback, especially if we want to avoid inadvertently harming them. JJ: How do you think diagnoses should be approached in therapy? How do you recommend clinicians approach these topics with people who come to see them?  JR: I think we often draw sort of an artificial line between diagnosis and treatment. George Kelly was the psychologist who developed personal construct theory, and he used to say that therapists have to continually revise their understandings of clients because clients are always in process and forever changing. That's why Kelly used the term transitive diagnosis. He said diagnoses are transitive because they are continually evolving. So given that, regardless of the diagnostic approach that a therapist takes, it seems to me very important for the therapist to not reify the diagnosis made because I think doing so locks the client in place in a way that can be highly limiting. That would be true across different diagnostic systems for me. Whichever system somebody’s adopting, you have to be careful not to be too literal or reifying about that system. So to me, thinking of diagnoses as meaningful constructions, as created understandings that might -for the time being- inform what we're doing, is terrific. But when we shift to seeing them as essential, unchangeable things we can lock ourselves in, and we can actually also unintentionally harm the people we're working with. JJ: More of a living system. JR: As Kelly said, you have to keep up with your clients. They're always in process, and you better keep up with them because if you're still using last week's a conceptualization and understanding, well, they may have moved on. JJ: Is there anything else that you wanted to add or talk to us about before we wrap up? JR: No, I mean just that I think this is a growing area that people are expressing interest in. I sense that a lot of clinicians don't really know much about different alternatives beyond the DSM and the ICD. And so, one of the things that I've been interested in recently is just helping the field have more knowledge; helping the clinicians out in the field become aware of approaches that they may not know much about. My sense is that clinicians are hungry for alternatives, but they don't necessarily know what the alternatives are. And then, at the same time, they also feel trapped in the sense that in order for them to get paid, they need to use the DSM. But it doesn’t mean, even if the issues of reimbursement haven't been resolved for other systems, it doesn't mean that they can't learn about and begin using these other systems in addition. It doesn't have to be an either-or. So my goal is to learn more about these diagnostic alternatives myself and then to help others out in the field learn about them as well. JJ: I think that's really great. Just talking about alternatives and getting the information out even if we do not necessarily subscribe to them or use them.  JR: Having an open discussion and dialogue about them is important, and I think people are very quick to make judgments about which approach they like or dislike. But I think if you want to develop alternatives, you have to be open-minded and be willing to talk with people who might be developing alternatives that are very different from what you yourself might develop and appreciate that each alternative may have advantages to it as well as disadvantages. JJ: I'm excited to see these theories evolve and to see how the field continues this conversation and I'm glad that you're a part of that. Your textbook compares and lays out the alternative diagnostic frameworks, right? JR: Yea, one of the things that I was very excited to do in the book was to present alternative perspectives across both diagnosis and treatment interventions. In the diagnosis chapter, I talk about RDoC; I talk about HiTop; I talk about the PTM framework; Because I think it's essential for students in the field to learn about these approaches. If we want to disseminate information about them, we have to cover them in the places where students are learning about them. I also spend a lot of time on DSM and ICD because those are the most influential approaches today. So all of them get covered, and they get covered as perspectives. Each one is a diagnostic perspective that a person might adopt depending on what the goal is in the given moment. JJ: Well I have to say, I really appreciate you doing this work. I appreciate your perspectives. I appreciate you coming on today and sharing this information with our readers. I do agree with you. I think it's so important to get this information out to people. Thank you so much for talking to us, and I look forward to hearing more about your work.  JR: Thank you very much. © Mad in America 2019